Your Third Trimester

Screening for Gestational Diabetes

This laboratory testing is done routinely for everyone at 28 weeks. In addition, it is also done in early pregnancy for those at high risk for diabetes.

Gestational Diabetes can be a serious complication of pregnancy, but fortunately, if identified and managed carefully, the impact can be minimized. The American Congress of Obstetricians and Gynecologists has more details on this disorder: ACOG Gestational Diabetes

At your 24 week visit we send home a glucose drink in order for you to be ready for the One Hour Glucose Challenge Test at your 28 week visit. This allows you to drink the beverage before your visit, saving you time, since we need to draw your blood exactly one hour after you finish consuming the drink. We also perform other routine blood tests at the same time.

Here are the directions:

Check to be sure that your glucose drink is labeled to contain 50 grams of glucose.

It is okay to eat low carbohydrate, low sugar meals the day of the appointment.

Plan to drink the glucola 45 minutes before arriving at the office. Please give yourself enough time to get here safely.

You should finish this drink within 5 minutes.

Do not eat anything once you have consumed this drink.

Tell the receptionist what time you finished drinking the glucola.

We will draw your blood 1 hour after that time.

For those whose blood glucose level is too high on this screening test, we will provide information on a follow up test to either diagnose or rule out gestational diabetes. The follow up test takes three hours and must be done fasting (no food after midnight).

Fetal Movement Counts

Feeling your baby move inside you is one of the joys of pregnancy. Women get used to the pattern of movements of their unborn baby. Recognizing when a baby is not moving as much as normal may be an early warning that intervention is needed. While movements may be less intense in later pregnancy when the baby is more crowded, the frequency of movements should remain steady.

A healthy baby is generally expected to move 10 times within 2 hours. Every shift of a knee, foot, elbow, or hand; each repositioning of the head; and every full body squirm, twist, or roll counts as a movement. (Hiccoughs don’t count, though, because they are unintentional.)

We recommend daily fetal movement counting starting at 28 weeks. Some babies are so active that in 15 minutes or less a mother will know that the baby is fine. Sometimes a woman senses that she hasn’t felt a lot of movement and needs to pay close attention to determine if her baby moves 10 times within 2 hours. Eating something or drinking juice or cold water might encourage fetal activity. Recording fetal movement counts is easy:

Write down the date and the start time.

Put a tally mark for each movement up to ten. (4 vertical marks with a slash represents 5)

Write down the time of the tenth movement and then write how many minutes it took.

If you get to 2 hours without feeling 10 movements, then you should call us.

[A free App, such as “Full Term”, can let you record Fetal Movement Counts on an iPhone.]

Rhogam if blood type is negative

For women whose blood type is Rh negative (A negative, B negative, AB negative, or O negative), special precautions are recommended during pregnancy. An injection called Rhogam is given if there is any risk that fetal blood may have entered the maternal bloodstream. This includes miscarriage, vaginal bleeding, or abdominal trauma. In addition, an injection of Rhogam is given at 28 weeks of pregnancy to protect against Rh sensitization that could occur in the third trimester.

Birth itself poses a risk, so Rhogam is given within 72 hours after the birth if the baby is Rh positive. We are happy to explain further at your prenatal visit.

Maternity Support Belt

Some women experience problems during pregnancy that can benefit from external support of their growing abdomen or their perineum. If we suggest this to you, then you can purchase a belt either online from a variety of vendors or at local stores. The following site has pictures and descriptions of tummy and vulvar support garments for pregnancy: Maternity Support Belts

Compression Stockings

Women with significant swelling or varicose veins in their legs may benefit from wearing special support stockings during the day while pregnant. We can provide a medical prescription for those with symptoms. We will discuss whether thigh-high or pantyhose is right for you, and recommend a compression strength. (The waist-high pantyhose do not compress your tummy, they just stay up better!)

10-15mmHg (mild)

15-20mm Hg (moderate)

20-30mmHg (firm, but some vendors call this "moderate", so numbers are more accurate)

* Pressure is measured in millimeters of mercury.

Correct fit is important. Some medical supply or specialty pharmacies have Certified Fitters to assist you. This website identifies a variety of brands for support stockings and has self-fitting directions: How to Measure for Compression Stockings

Whooping Cough (Pertussis) Vaccine

The CDC recommends that all pregnant women get the Tdap vaccine during their third trimester of each pregnancy to protect their newborn from pertussis.

Infant Care & Infant CPR Classes

Breastfeeding

Inova Fair Oaks Hospital has experienced nurses, a postpartum breastfeeding class, and Board-Certified Lactation Consultants to help you with breastfeeding after your baby is born. Nonetheless, new mothers are often a bit overwhelmed after labor and birth; and sleep is interrupted feeding the baby at night. That is why a breastfeeding class during pregnancy can give mothers such a valuable advantage. You can scroll down to select a location and register: Inova Breastfeeding Class

You may want to purchase a breast pump, especially if you plan to return to work while breastfeeding. Talk to us about a prescription for a pump for filing with your insurance company.

Circumcision Decision

Circumcision is an elective surgery to remove the foreskin from the penis. We want parents to be fully informed regarding the risks and benefits of this procedure as they make a decision whether or not to request it. Our obstetricians perform circumcisions at Inova Fair Oaks Hospital; usually on the day after delivery if baby is healthy. Please see information from the American Academy of Pediatrics (AAP):

Birth Plans

Whether this is your first baby or your fifth, you probably have some preferences about your care.

What family members or friends do you want to be present for the birth? Are you interested in natural childbirth or planning to get an epidural? Do you relax better with talking and joking going on or do you prefer a quiet atmosphere so that you can focus? Is it important to you to have your baby skin-to-skin right away? Any special photos you are hoping can be taken?

Childbirth education classes, reading, or past experiences may help you think about your vision and concerns. Flexibility is important, because none of us can predict how your birth will unfold, but we want to understand your priorities. Don’t worry -- a healthy baby and a healthy mother will always top the list! We welcome your written notes to aide discussion and to become a part of your file so that all team members will know how best to provide personalized support.

Breech Babies

It is estimated that roughly 96% of babies will be in a vertex or “head down” position by 36 weeks. Most of the rest will be breech or “bottom down”. For those babies who are still breech during labor, cesarean delivery has been demonstrated to be safer than vaginal birth. This is because of simple anatomy. Since the baby’s abdomen comes out before the head, the umbilical cord necessarily lies alongside the baby’s head as the head passes through the bony pelvis. This can compress the cord, reducing or cutting off the baby’s oxygen supply. Also, the fetal chin may not tuck to help the head fit.

There are some techniques to try to get a breech baby to flip, each with limited success rates.Feel free talk to us about the options.

Group Beta Strep

At your 36 week visit we collect a vaginal swab to identify women who are carriers of the bacteria Group B Streptococcus (“GBS” for short). Carriers have no infection and no symptoms. The concern is only for babies, who can acquire this bacteria during the birth and develop a serious, sometimes life-threatening infection. By knowing who is a carrier, we can treat affected women with intravenous antibiotics during labor and significantly reduce the risk of the baby getting sick.

Family Planning for Postpartum

Before your baby is born, we want you to take a moment to think about the future. If getting pregnant again immediately is not part of your vision, then we are happy to discuss birth control options. Natural Family Planning, condoms, diaphragm, birth control pills, long acting reversible contraceptives including implants and intrauterine devices, as well as permanent methods are all available. Only you know what is right for you.